Lead Transactional Claims (7371)

Terros Health is a healthcare organization of caring people guided by our core values of integrity compassion and empowerment with diversity woven throughout. We engage people in whole person health through an integrated care delivery system thus establishing a medical home for our caring for the whole person we focus on overall wellness through physical health mental health and substance use care. Our mission is to provide extraordinary care by empowered people through exceptional outcomes.

The Lead Transactional Claims position is responsible in maintaining the integrity of pre-billing through Clearinghouse rejection transactions to ensure maximum efficiency and accuracy of billed services. This position is also responsible for training and mentoring of teammates. The lead will oversee the holding tank unbilled and billed in error reports weekly. The lead is also responsible for updating the weekly and monthly metrics. This position reports to the Director Claims and Credentialing.

• Processing of prebill claim edits in RCx Rules and NextGen EPM.
• Resolves unbilled and pending charges to ensure team is working within guidelines for billing accuracy
• Reconciles daily reporting from multiple systems including NextGen EPM Waystar Clearinghouse and RCX.
• Provides quality assurance and productivity reports to manager when requested.
• Maintains own split of work to achieve proficient workflows. Maintains and updates job aids.
• Reviews and improves where necessary processes for billing of services and reconciliation with improved accuracy and timeliness in mind.
• Identifies and provides action plans for issues discrepancies and opportunities for improvement to management.
• Proactively engages in process improvement on a continuous basis
• Train and mentor teammates for the ultimate outcome of delivering excellent results and meeting timelines for productivity.
• Helps to coordinate special projects and Accounts Receivable reporting and workload distribution to team members.
• Builds and maintains relationships with internal and external cross functional partners payers and business partners.
• Ensure that Federal and State regulations are followed

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Benefits & Wellness

• Multiple medical plans - including a no premium plan for employees and their families
• Multiple dental plans - including orthodontia
• Financial well-being - 401(k) with a company match interest free medical line of credit financial education planning and support
• 4 Weeks of paid time off in the first year
• Wellness program
• Pet Insurance
• Group life and disability insurance
• Employee Assistance Program for the Whole Family
• Personal and family mental and physical health access
• Professional growth & development - including scholarships clinical supervision and CEUs
• Tuition discounts with GCU and The University of Phoenix
• Working Advantage - Employee perks and discounts
  • Gym memberships
  • Car rentals
  • Flights hotels movies and more
• Bilingual pay differential

• High School diploma or GED equivalent required. Bachelors degree or Associates degree in related field highly preferred
• 5 years medical and/or behavioral billing experience especially in the area of account and payment reconciliation
• 5 years experience with medical terminology and using an electronic medical record and billing system.
• 2 years experience mentoring and training others on claims and/or coding functions and overseeing complex Accounts Receivable projects.
• Demonstrated knowledge of HCPCs CPT and diagnosis codes highly preferred.
• Intermediate knowledge of Microsoft suite especially excel functions and tools.
• Experience interacting with external payers and stakeholders
• Excellent written and verbal communication skills with ability to communicate effectively with colleagues
• This role is a non-driving position. Must be 18 years of age and with less than two years driving experience or no driving experience
• Must pass a TB test a criminal background check and drug test

Physical demands of this position are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.